COVID-19 Patron Health Screening Questionnaire


    yesno


    yesno


    yesno


    yesno

    Fever or chills (fever of 100.4 degrees Fahrenheit (°F) or higher, or report feeling feverish)
    yesno

    Cough
    yesno

    Shortness of breath or difficulty breathing
    yesno

    Fatigue
    yesno

    Muscle or body aches
    yesno

    Headache
    yesno

    New loss of taste or smell
    yesno

    Sore throat
    yesno

    Congestion or runny nose
    yesno

    Nausea or vomiting
    yesno

    Diarrhea
    yesno


    yesno

    As per NY State law people are not allowed to congregate indoors for online classes without bweing vaccinated. Please feel free to join our donation based Zoom Classes.

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